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Re: Эндопротезирование на фоне последствий политравмы
послал Terry Finlayson 10 Июль 2003, 02:52
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Tough case!
1. I would take down right femur nonunion and correct translation (it looks at very high risk to refracture), shortening and mild flexion deformity (these latter two corrections look like they would gain at least 1 cm of length.
2. Explore left knee/extensor mechanism. If adequate patellar tendon/quad tendon integrity and at least 60 degrees arc of motion (including full extension), I would attempt extensor mechanism repair/reconstruction (the specifics would depend on the exact findings). If repair/reconstruction not feasible or ROM too limited I would proceed to knee arthrodesis, at which time 1-2 cm shortening of left side could be done.
3. Left THA can be done, but I wouldn't try to shorten very much at THA site because he's already short due to protrusio (compare levels of lesser trochanters to your reference of choice on the pelvis) and any significant shortening at hip may lead to poor abductor tension and attendant risk of dislocation (offset stem and liner options may allow correction for these).
4. If left hip pain is main problem, I would consider doing all left extremity procedures initially; however, I'd be concerned about that malunion on the right absorbing more loading.
Terry I. Finlayson, M.D.
Alpine Orthopaedic Specialists
2380 North 400 East Suite A
North Logan, UT 84341
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